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Dec. 20, 2010 -- Sunless tanning sprays and products are often promoted as ways to look tanned while avoiding the dangers of ultraviolet (UV) radiation from the sun and indoor tanning beds, but a new study shows that sunless tanners are actually more likely to frequent indoor tanning salons.

"Our finding suggests that, instead of substitution, women and men use both means to obtain a tan-looking appearance," conclude researchers, who were led byKelvin Choi, PhD, of the University of Minnesota in Minneapolis.

The new report, which appears in the December issue of Archives of Dermatology, also showed that women are more likely than men to use indoor tanning facilities and that many people are not aware that avoiding tanning beds can decrease their risk for skin cancer.

Even in an economic downturn, the indoor tanning industry appears to be booming. It has generated more than $5 billion in yearly revenues and attracts more than 30 million tanners each year, according to information cited in the new study. A 10% tax on indoor tanning went into effect on July 1, 2010.

Spray Tanners Also Use Tanning Beds

Choi and colleagues analyzed data from a 2005 study of 2,869 people aged 18 to 64. Study participants answered questions about their lifestyles and indoor tanning habits. In the study, 18.1% of women and 6.3% of men said they went to an indoor tanning facility during the previous year. Female indoor tanners were more likely to live in the Midwest or South and use sunless, spray tanning products. Women who were less likely to use indoor tanning beds were older, less educated, earned less, and were more likely to use sunscreen, the study showed.

Among men, those who were older and obese were less likely to visit tanning salons. By contrast, men who used spray tanning products and lived in cities were more likely to go indoor tanning, the study showed.

“The reality is that sunless tanners want to look tan whether with sunless tanning products, indoor tanning, or on the beach,” says Mathew M. Avram, MD, a dermatologist at Massachusetts General Hospital in Boston.

One of the reasons that indoor tanning salons have held their own during the recession may be that they are an inexpensive alternative to a time-share in the Hamptons or a winter getaway in St. Barts, he says.

“People really care about how they look, and they think that being tan makes them look good,” he says.

Message About Indoor Tanning and Skin Cancer Is Not Getting Through

In a subset of 821 people who were asked what they knew about skin cancer prevention, just 13.3% of women and 4.2% of men said that avoiding tanning beds was one of the ways to stave off skin cancer. Participants did commonly acknowledge that using sunscreen, avoiding the sun, and wearing a hat were preventive measures.

As to why, they write, "perhaps people are confused by the messages from the indoor tanning industry on possible benefits of indoor tanning, e.g. getting vitamin D from moderate exposure to artificial UV radiation.” Vitamin D is known as the sunshine vitamin because our bodies produce it when exposed to sunlight.

Going forward, "strategies such as clinician-patient communication and media campaigns that focus on strategically disseminating the harms of indoor tanning to the adult population may be needed to reduce the prevalence of indoor tanning among adults in the United States," they conclude.

Heidi Waldorf, MD, director of dermatologic laser surgery at Mt. Sinai Medical Center in New York City, says “we have obviously been getting the message across about sun protection and the sun being a major cause of skin cancer and premature aging, but not indoor tanning.”

What will it take to really hammer home the message?

“It is going to take one of these younger women who has been tanning to come forward and say they have skin cancer,” Waldorf says.

Unless and until that occurs, word of mouth helps, she says.

“We have to keep chipping away and educate people, and every time we educate one person, they tell two people and then they tell two people,” she says.

Like Mother, Like Daughter

In a related letter in the same journal, Mary Kate Baker, MPH, of East Tennessee State University in Johnson City, Tenn., writes that many female tanners went tanning for the first time with their mothers.

Of those who went tanning with their mom for the first time, 81% still went tanning and 31.9% were heavy tanners, which is defined in this study as tanning more than 25 times per year.

People who tanned with their mother for the first time were nearly five times as likely to be heavy, current tanners as people who went tanning by themselves or with someone other than their mother for the first time.

“Interventions directed at mothers before the child initiates tanning have the potential to lead to reduced tanning in the mother and reduced tanning initiation and frequency in the child,” the authors conclude.

Industry Responds

John Overstreet, the executive director of the Washington, D.C.,-based Indoor Tanning Association, an industry trade group, says the jury is still out on any potential hazards associated with indoor tanning.

“Individuals and groups who argue against exposure to UV light and/or sunbeds use would have the public believe there is scientific consensus about the risks,” he tells WebMD. “This is absolutely false."

There are many benefits to exposure to UV light, whether from the sun or a sunbed, he says.

“There are risks and benefits to tanning outdoors and indoors, but in moderation and based on skin type and predisposed risk factors, people can make a judgment for themselves.”